ABSTRACT Black women have among the highest prevalence of hypertension of all other racial and ethnic groups in the world, and hypertension is a primary risk factor for other forms of cardiovascular disease (CVD) such as stroke. Twenty years of health disparities research has largely focused on studying the health behaviors of Black women with hypertension with little improvement in either their blood pressure or their overall CV health. An emerging area of CVD research shows that early life stress, like severe household dysfunction and child maltreatment, independently doubles the odds of CVD even after controlling for traditional risk behaviors. Yet, few studies have investigated the potential association of early life stress and hypertension in Black females. Even fewer studies have used a strengths-based approach to understand Black females who experience early life stress but maintain a healthy blood pressure. Individual, family and community supports are positive social determinants of health that may work together to buffer the negative effects of early life stress on blood pressure in Black females, but we know little about these relationships. To fill this gap, the overall goal of this descriptive, correlational study is to examine the influence of early life stress, defined as exposure to adverse childhood events (ACEs), on hypertension and determine the extent to which positive social determinants of health counter the effects of ACEs using data from 14 years of follow-up in 900 young Black women, ages 24- 32, who participated in the National Longitudinal Study of Adolescent to Adult Health. The specific aims of this study are to (1) determine the relationship between cumulative positive social determinants of health at the individual (spirituality), family (parental relationships), and community (social connections) levels and severity of early life stress (ACEs) on both blood pressure and the absence of hypertension among Black females who experienced ACEs; and (2) explore the individual contribution of each positive social determinant of health and severity of early life stress (ACEs) on blood pressure and the absence of hypertension among Black females with a history of ACEs. This study may help to shift the paradigm of health disparities research to focus on leveraging strengths that may inform future tailored, culturally sensitive interventions to improve the CV health of Black women. In addition to supporting completion of the proposed study, this fellowship will support the development of an independent scientist by providing extensive 1:1 mentoring and training in health equity research, secondary data analysis of large datasets, and dissemination of scientific knowledge. These goals will be achieved in a strong research environment with a long history of NIH funding. Building on a strong clinical foundation in community- based primary care, this fellowship will provide the applicant with research training to prepare for a postdoctoral fellowship that builds on the proposed study to examine gene-environment interactions and CVD in populations of color. The fellowship and training goals will cultivate the applicant’s expertise in CVD, the biological effects of stress on women’s health, and the use of large databases to answer rigorous research questions.

Public Health Relevance Statement Black women experience significantly higher rates of high blood pressure and heart disease than other females in the U.S. and these outcomes have improved minimally with current strategies for disease prevention. Using a novel strengths-based approach, the proposed study will explore positive social determinants of health, such as parental relationships and social connectedness, among a cohort of young Black women who have experienced early life stress, a well-documented risk factor for heart disease. Findings will inform future research aimed at reducing heart disease risk, including providing important data about the timing and content of future interventions, which will promote heart health and equity among young Black women.